Indian Journal of Community Medicine最新文献

Background: Critical illnesses such as cardiovascular diseases, stroke, cancer etc., are known to cause heavy financial burden for the patient and their caregivers despite having insurance coverage and high out-of-pocket expenditure (OPE) is still incurred due to the poor knowledge and awareness regarding the type of policy. The present study aims to evaluate the OPE of critical care insured patients admitted in a tertiary care hospital.

Materials and methods: This study was conducted at Kasturba Hospital, Manipal from September 2020 to September 2022, among patients with eight critical illness admitted under selected health insurance (HI), and this study was cross-sectional in nature.

Results: Results depicted that 98.8% of the patients incurred OPE (22.6% incurred a high OPE of >Rs. 50,000). 24.3% of the total bill was paid as OPE. The overall median OPE was Rs 14,160 [Inter Quartile Range (IQR)-Rs. 5728.5-42506], but the difference in median OPE among government and private HI was not statistically significant. Increased duration of stay in hospital and prolonged stay in intensive care unit (ICU) were associated with an OPE of >Rs. 50,000 (Rs = Indian National Rupees).

Conclusion: Prolonged duration of admission and prolonged stay in ICU were found to be associated with an out-of-pocket expenditure of >Rs. 50,000. There is a need to create awareness among public regarding the different clauses of a HI policy (inclusions, exclusions, top up facility, co-payment option, deductibles, limits, riders etc.) before they enroll into any policy.

Background: Risk of diabetes continues to increase worldwide due to population growth, urbanization. Little is known regarding the health related quality of life (HRQoL) among diabetes mellitus in India. Identifying factors influencing HRQoL could help us to form strategies for better control of diabetes.

Material and methods: To measure the quality of life among men with type 2 diabetes mellitus residing in the rural field practice area of a teaching hospital in Coimbatore and to determine sociodemographic as well as diabetes and sexual related characteristics associated with poor quality of life. This study was conducted in the rural field catchment area by enrolling 443 adult males with type 2 diabetes mellitus. The data was collected from the blood investigation reports and by face-to-face interviews using a Semi-structured. Quality of Life was assessed using the European quality of life five-dimension scale (EQ 5D 3L). A question on erectile dysfunction was also included. Logistic regression models were used to investigate the factors associated with it.

Results: Patients reported "some or extreme problems" most frequently in pain/discomfort (34.8%), and in anxiety/depression (27.7%) dimensions. Older age, long duration of diabetes, having co-morbid conditions were significantly associated (P < 0.05) with mobility, self-care, usual activities, and pain/discomfort of EQ 5D in the multivariate regression model. It is also observed that 60.9% of these patients had erectile dysfunction, which was found significantly associated with increasing blood sugar values (P < 0.001).

Conclusion: The study results indicated that patients with diabetes suffer from a relatively poor quality of life. More attention should be paid to the determinants of the poor quality of life. It is recommended that factors leading to derangement of quality of life as well as causing sexual dysfunction have to be addressed by the primary health care providers for the improvement of the quality of life of diabetic patients attending the primary health care center.

Introduction: In most developing countries, open defecation is the "way of life." Worldwide 2.0 billion population still lack basic sanitation facilities and they continue to practice open defecation. Despite developing many programs, open air defecation remains common among rural population. This study aims to bring a behavioral change among individuals who practice open air defecation.

Methods: A baseline survey was conducted, among all residents using a structured questionnaire. Then an in-depth interview was conducted to find out the factors contributing latrine usage and open defecation practice. Six monthly community-based interventions promoting latrine usage was given through various methods. At the end of 6 months an end-line survey was conducted among the same participants as base-line survey to see the change in their practice. Analysis was conducted using SPSS software. Socio demographic factors, housing condition, waste disposal, latrine availability, latrine usage, reasons for sanitary latrine usage and reasons for open defecation were described as frequency and proportions. McNemer test was used to measure the P value (Comparing the sanitary latrine usage before and after intervention). P value less than 0.05 was considered statistically significant.

Results: Out of 57 households, 40 (70.2%) had latrine facility at the end of 6 months intervention compared to 33 (57.9%) in baseline survey and out of 223 individuals, 123 (55.2%) individuals were using latrine during end-line survey versus 92 (41.3%) individuals in baseline survey. There was a 13.9% increase in latrine usage following intervention. Improper drainage facility, cultural beliefs, unavailability of latrine, habitual practice, and smell when latrine is being used were some factors associated with open defecation practice.

Conclusion: Community health improvement process has led to change in behavior among the study population and the practice of open defecation has reduced among some individuals. Community had varied perception regarding advantages and disadvantages of using sanitary latrine that was addressed during the intervention.

[This corrects the article on p. 1 in vol. 50, PMID: 40124828.].

Introduction: More than 40 million people in India are thought to be chronically infected with hepatitis B. Though envisaged in the year 2019, the national program for control of viral hepatitis is still in very nascent stage of implementation. The management of hepatitis B after diagnosis is heterogeneous all across the country and mostly out of reach of the vulnerable rural population far from cities with low socioeconomic status. There is a need to explore the impact of disease and the challenges faced by the patients and their partners.

Methodology: The study is a qualitative research using in-depth interviews of the married couples with one of the partners diagnosed positive for HBsAg since at least 1 year. The interviews were conducted in vernacular language and transcripted by translation and back translation. The transcription was coded and thematically analyzed before interpretation of the results. The analysis was done using Atlas Ti software (version 7.1.8).

Results: Themes identified in the interview were related to disease diagnosis, disease management, disease awareness, and impact on social or marital life. The awareness about the disease source or complication was suboptimal but awareness about sexual transmission of the infection was high. The disease diagnosis was mostly incidental, and in the majority of cases, they were diagnosed during pre-surgical tests. Most of the patients were not educated about the disease, lifelong treatment, prevention or screening among the family members, referral, or appropriate follow-ups. The availability of the medicines is a huge problem, and hence, all of our participants were non-adherent to medication.

Conclusion: The findings of the study are valuable in view of huge burden of the disease and unavailability of universal treatment or information about the disease. The diseased person's experiences low discrimination or stigma as compared to other blood-borne infections, and hence, the epidemiology of disease provides an unique window of opportunity for awareness through authentic health information regarding the infection, prevention through vaccination, and screening. There is also a need for widespread provision of disease medications and standard guidelines for management.

Background: Elective as a part of curriculum in medical education was implemented with the aim that students can explore various areas of interest during elective posting within the medical profession with personal interest and career goals to determine the best fit. This study aimed to develop and validate a scale to assess the perception of elective module block-2 among undergraduate medical students.

Materials and methods: It was a cross-sectional study in which 181 medical undergraduate students were participated. We conducted a literature search, generated items, and verified the content validity of 40 items. Elective module scale was developed on 26 items following principal component analysis and structural equation modeling where responses to these items were based on a 5-point Likert Scale ranging from "strongly agree" to "strongly disagree," A Confirmatory factor analysis was conducted to explore the components of each state.

Results: Factors jointly accounted for 66.5% variance. Cronbach's α =0.947 and McDonald's ω =0.953 of EM-26 indicates a very good internal consistency.

Conclusion: This study concluded that the developed scale showed good reliability, validity, and psychometric properties.

Background: Loss to follow-up and noncompliance to anti-tuberculosis treatment (ATT) are the main causes of recurrence of tuberculosis (TB). In this study, we aim to investigate the effect of nutritional supplements as a treatment enhancer to help patients with pulmonary TB (PTB) on a retreatment regimen to complete ATT, reduce loss to follow-up, and thus increase favorable outcomes in a programmatic setting.

Methods: In this prospective community interventional study conducted under NTEP program in the Vellore district of Tamil Nadu during 2017-2019, PTB patients on a retreatment regimen were given a nutritional supplement. The supplement, given fortnightly as a 500 gm pack of enriched flour, was distributed to all the tuberculin units of Vellore in a phased manner. The flour consisted of finger millet (ragi), rice flakes, groundnuts, and roasted Bengal gram with advice to cook and consume 30 gm per day with milk or hot water. ATT was given as per the National Program guidelines. Phased implementation of the supplement was performed in the tuberculosis unit, while the others were considered as control groups.

Results: We enrolled 415 adult PTB patients on a retreatment regimen. Of them, 284 (68%) patients received the nutritional supplement, and 131 (32%) did not receive the nutritional supplement. There was a 28% significant decrease in unfavorable outcomes among the intervention group (adjusted risk ratio [aRR] -0.72 (0.57-0.90) when compared to the control arm. There was also a significant increase in weight and mid-arm circumference over the follow-up period of 14 months in the intervention arm. There was a significant improvement in social relationships and environmental domains in quality of life among the intervention group.

Conclusion: In a program setting, nutritional supplement not only increases weight but also act as treatment enhancers. This improves treatment completion and reduces unfavorable outcomes among retreatment patients.

Background: City bus drivers are more prone to work-related musculoskeletal disorders (WRMSDs) due to the nature of their work, yet city bus drivers are the least studied population. The present study aims to assess WRMSDs in city bus drivers and to determine some factors related to them.

Methods and materials: The present cross-sectional study was conducted among bus drivers belonging to three bus depots of the city bus service. A simple random sampling was done to select the estimated sample size of 383 bus drivers. Data were collected by interview method using a self-designed questionnaire. The musculoskeletal disorders were assessed using the Cornell Musculoskeletal Discomfort Questionnaire. Univariate and multivariate analyses were done using Stata 17.

Results: More than half of the bus drivers (202 (52.74%)) had WRMSDs, with 157 (40.99%) bus drivers having lower back discomfort. On univariate analysis, it was found that duration of driving ≥20 years (P = 0.007); driving distance ≥ 150 km (P = 0.001); waist-hip ratio ≥ 0.9 (P = 0.004); and self-perceived workstation factors such as seat adjustability (P = 0.04), seat comfortableness (P = 0.01), and body contour of the seat (P = 0.02); and congestion on the bus route (P = 0.05) were significantly related to musculoskeletal disorders. However, on multivariate logistic regression, driving distance ≥150 km per day, seat uncomfortableness, and lack of body contour of the seat were found to be statistically significant independent factors related to WRMSDs.

Conclusion: As the daily driving distance, seat uncomfortableness, and lack of body contour of the seat were statistically significantly related to WRMSDs, it is recommended that all the buses be retrofitted with proper ergonomically designed driver's seats, and the daily average driving distance should be reduced.

Background: Medical students are at high risk for poor sleep quality because of academic pressures. Physical activity improves sleep in general populations but has been understudied by medical students. This study aimed 1) to assess the association between physical activity levels and sleep quality among Indian medical students and 2) to explore student perceptions about barriers/facilitators influencing sleep and exercise patterns through a mixed methods design.

Materials and methods: A mixed-method study (cross-sectional and qualitative study) was conducted among 380 medical students who completed the Pittsburgh Sleep Quality Index (PSQI), International Physical Activity Questionnaire (IPAQ), and sociodemographics. A sub-sample of 20 students also participated in semistructured interviews regarding sleep health and barriers/motivators for physical activity. Multivariate logistic regression analysis was used in the quantitative strand. Inductive coding identified themes from qualitative interviews.

Results: 380 medical students participated (mean age 21.5 ± 1.8 years, 60% female). Overall, 57% had poor sleep quality (PSQI > 5). In univariate analyses, students with low physical activity (PA) had worse PSQI scores than moderate and high PA groups (mean PSQI 7.8 vs 6.1 vs 4.9, P < 0.001). Male gender, clinical training years, and overweight/obesity were also associated with higher PSQI scores (all P < 0.05). In multivariate logistic regression, compared with low PA, moderate PA (AOR = 0.40, 95% CI: 0.25-0.64), and high PA (AOR = 0.15, 95% CI: 0.08-0.28) were associated with significantly lower odds of poor sleep quality after adjusting for covariates. Qualitative interviews with students (n = 20) revealed perceived barriers to academic workload interfering with sleep and exercise behaviors.

Conclusion: Higher physical activity correlates with superior self-reported sleep quality in this medical student sample. Integrating activity promotion into medical school curricula may improve sleep health among students facing considerable lifestyle challenges.

Introduction: Acute respiratory infections (ARIs) remain the leading global cause of death in children under-five. Targeted initiatives are needed to address healthcare inequities and reduce under-five mortality, particularly in disproportionately impacted low- and middle- income countries. To inform initiatives and identify high-risk groups, this study explored regional risk factors for ARIs among Indian children.

Material and methods: Our retrospective, observational study utilized India's National Family Health Survey (NFHS-5). Bivariate and multivariable models were employed to investigate associations between respiratory infections and explanatory variables, including environmental factors, child characteristics, maternal characteristics, enabling factors, and household characteristics.

Results: Of the 201,133 children under-five included in our sample, 2.85% [2.78-2.92%] experienced a recent respiratory infection. In multivariate analysis, children from northern and central regions had the highest odds of infection, while those from the southern region had the lowest. Healthcare accessibility, maternal smoking, caste, age (child), and birthweight were among additional variables associated with infections. Our study revealed significant regional differences in prevalence of acute respiratory infection symptoms. Notably, inability to access healthcare increased a child's risk of infection. Several states in southern India, which typically had lower ARI symptom rates, have adopted initiatives to strengthen public health infrastructure, including the WHO's Integrated Management of Neonatal and Childhood Illnesses program. Such initiatives could serve as models for broader health improvement efforts across regions. Furthermore, observed variability in disease burden suggests that with detailed and deliberate implementation of programs, advancements in under-five mortality due to ARI can be achieved.